Koroner bypass cerrahisinde aantegrad kardiyopleji yönteminin antegrad-retrograd kardiyopleji yöntemi ile inflamatuar cevap ve sol ventrikül sistolik fonksiyonları açısından kıyaslanması: prospektif randomize çalışma

Abstract

Amaç: Özellikle proksimal darlığı olan koroner arter hastalarında veya ciddi miyokardiyal hipertrofisi olan hastalarda antegrad kardiyoplejinin homojen olmayan dağılımı ciddi bir problemdir. Bu prospektif randomize çalışmada, kombine antegrad-retrograd kardiyoplejinin sadece antegrad tekniğe kıyasla erken dönemde daha iyi miyokardiyal koruma sağlaması ve daha iyi laboratuar sonuçları ile ilişkisi değerlendirilmiştir.

Gereç ve Yöntemler: Koroner bypass cerrahisi uygulanan 60 hasta (45 (%75) erkek, 15 (%25) kadın) çalışmaya dahil edilmiştir ve iki grupta incelenmiştir: Grup 1’de 30 hastaya aort kökünden antegrad ve koroner sinusten retrograd yolla kombine kardiyopleji; Grup 2’de ise 30 hastaya aort kökünden antegrad kardiyopleji verildi. Preoperatif, intraoperatif ve postoperative altıncı günde alınan kan örneklerinden CK-MB, TpI, TNF- α, IL-1, IMA, ICAM-1 ve BNP parametreleri çalışıldı. Hastalar preoperative olarak ve postoperative altıncı günde transtorasik ekokardiyografi ile değerlendirildi.

Bulgular: Postoperatif ortalama EF düşüşü Grup 1’de Grup 2’ye kıyasla istatistiksel olarak anlamlı şekilde daha az oldu (4.13 ± 9.09 ve 8.90 ± 10.76, sırayla Grup 1 ve Grup 2, p=0.046). TNF- α seviyelerindeki değişimin büyüklüğü kıyaslandığında Grup 2’deki artışın daha fazla olduğu bulunmuştur (p=0.047).

Sonuçlar: Antegrad ve retrograd kardiyoplejinin birlikte uygulanmasının, erken postoperatif dönemde tek başına antegrad kardiyoplejiye göre daha iyi miyokardiyal koruma sağlayabileceği sonucuna vardık.

Keywords

• antegrad,inflamasyon,kardiyopleji,miyokardiyal koruma,retrograd

Comparison of effect of antegrade with combined antegrade/retrograde cardioplegia on inflammatory response and left ventricular systolic function in coronary bypass surgery: a prospective randomized study

Abstract

Aim: Nonhomogeneous distribution of antegrade cardioplegia especially in cases with severe myocardial hypertrophy or proximal stenosis of coronary arteries may be a serious problem. This prospective randomized study was designed to determine whether combined antegrade–retrograde cardioplegia provides improved myocardial protection in the early period and is associated with better laboratory results compared with antegrade technique alone.

Material and Methods: A total of 60 patients who underwent coronary artery bypass grafting surgery, 45 (75%) males and 15 (25%) females, were included in the study as 2 groups: In Group 1, 30 patients were given the combined cardioplegia solution antegrade via the aortic root and retrograde via the coronary sinus, in Group 2, 30 patients were given only antegrade cardioplegia solution via the aortic root. The CK-MB, TpI, TNF- α, IL-1, IMA, ICAM-1, and BNP parameters were studied in the blood samples which were taken preoperatively, intraoperatively and postoperative sixth day. The patients were evaluated preoperatively and on the sixth postoperative day using transthoracic echocardiography.

Results: The postoperative mean EF decrease was significantly lower in Group 1 compared to Group 2 (4.13 ± 9.09 vs 8.90 ± 10.76 in Group 1 vs. Group 2, respectively, p=0.046). When the change in TNF-α levels were compared between groups 1 and 2, the magnitude of increase in TNF-α was significantly higher in Group 2 (p=0.047).

Conclusion: We concluded that co-administration of antegrade and retrograde cardioplegia may provide improved myocardial protection compared to antegrade cardioplegia method alone in the early postoperative period.

Keywords

• antegrade,cardioplegia,inflammation,myocardial protection,retrograde

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